Later pub hours won’t fix the economy, but could worsen a growing public health challenge

Alcohol-specific deaths are at record highs, inequalities are widening and alcohol-related harm costs billions. So why is England considering making drinking easier?

The latest Chief Medical Officer (CMO) report confirms a concerning trend initially signalled in ONS and OHID data. Alcohol-specific deaths have been increasing in England since the pandemic, with the trend showing no signs of reversing. At the same time, the government is reportedly considering extending pub opening hours as part of a wider review of the alcohol licensing process. This risks deepening an urgent public health challenge that will need concerted policy efforts to tackle. 

A reversal of pre-pandemic trends

Before COVID-19, there were reasons for cautious optimism on alcohol mortality. Our own research showed that among 25–49-year-olds, alcohol-related mortality had levelled off for women and declined for men from 2010 to 2019.

The new CMO report paints a very different picture. Since 2020 alcohol-specific deaths have surged and remained high. Deprived areas have particularly been affected. The North East of England has rates almost double the national average, and now has more alcohol-related deaths than neighbouring Scotland. Meanwhile Scotland, which introduced minimum unit pricing in 2018, has not seen the same rise in deaths – a contrast that underlines the important role of policy in preventing alcohol-related harm.  

Inequalities and the ‘alcohol harm paradox’

Alcohol harms across society are deeply unequal. The alcohol-specific death rate in the poorest areas of England is double those in the wealthiest, and the gap is widening. This is despite the most disadvantaged groups having comparatively lower rates of risky drinking behaviours (drinking in excess of 14 units a week) than the least disadvantaged. 

This is known as the alcohol harm paradox: for the same amount of alcohol consumed, people in more deprived areas suffer greater health consequences. This can be for a number of reasons, including a greater concentration of risk factors, higher rates of underlying co-morbidities and more limited access to health care and support services.

The report shows patterns of alcohol consumption over the past 40 years have also changed. Alcohol in England is now more affordable than ever, and there has been a consistent shift since the 1990s when the majority of alcohol purchasing took place in pubs, bars and restaurants. Now, around 70% of alcohol is sold off-trade (ie in supermarkets or off-licenses) where it is cheaper. We know that those drinking alcohol at harmful levels, especially those on low incomes, are the most likely to purchase cheaper, off-trade alcohol. 

Extending pub opening hours: the wrong signal?

Against this backdrop, the government’s recent proposals to reform alcohol licensing, including longer licensing hours, feel out of step. From an increase in injuries, violence and emergency admissions, systematic reviews show that extending opening hours can increase harm across many alcohol-related outcomes at a time when we need to be thinking about how to bring these down. Although the review of licensing regulations primarily focuses on making things easier for pubs, bars and restaurants, the legal and regulatory changes proposed to licensing conditions and statutory requirements will also have implications for off-trade alcohol sales that are a bigger driver of harm. 

The government cites economic growth as motivation for this consultation. But it is unlikely these measures will address the core pressures facing pubs and hospitality venues, such as rising operational costs and reduced customer spending. Nor will the measures reverse the economic constraints driving reduced footfall and consumption. 

Meanwhile, alcohol-related harm already costs England an estimated £27.4bn a year. This includes £5.06bn in lost productivity and a loss of 17 million working days annually. Increased availability of alcohol, including longer hours or relaxed licensing processes, will lead to higher alcohol consumption and subsequent harms. Extending opening hours would serve to trade short-term hospitality gains for long-term health and productivity losses, and it is unlikely that any revenue increase would match the corresponding increase in the costs of alcohol-related harm it would cause. Other levers, such as policies to reduce energy costs, could help support hospitality venues without fuelling alcohol-related harm. 

The government’s other ambitions for the consultation, such as boosting social and cultural participation and community regeneration, are commendable as these factors have a positive impact on health. While pubs have an important role in communities, there are other ways to achieve these ambitions without anchoring them to the alcohol industry.  

What does the 10-year plan say on alcohol?

The 10-Year Health Plan for England promises a shift from ‘sickness to prevention’. On alcohol, however, the measures are unambitious: mandatory health warnings and nutritional information on alcohol labels; a consultation on no-alcohol and low-alcohol products; and support for the alcohol-free sector. 

The plan sidesteps some of the most effective, evidence-based policies such as minimum unit pricing, tighter restrictions on marketing and sponsorship, and controls on availability. These were reportedly considered in early drafts but dropped after industry lobbying. Critics (including Alcohol Change UK and the Institute of Alcohol Studies) argue that the plan is a ‘missed opportunity’ to tackle record-high deaths and widening inequalities. The plan also fails to acknowledge that cuts to the public health grant have led to a 25% cut in spending on drugs and alcohol services, meaning fewer people get help when they need it.

The evidence is clear on what interventions work to reduce alcohol-related harms and restricting availability is high up the list, including through limiting opening hours. Additionally, we have good real-world evidence of successful policy in the UK. An independent analysis of Scotland’s minimum unit pricing policy estimates it has reduced alcohol-specific deaths by around 13%, with the biggest gains in deprived areas. WHO calls pricing one of the most cost-effective ‘best buys’ for reducing harm. Health Foundation polling shows that almost half the population support minimum unit pricing and tighter marketing rules for alcohol. 

Where next? 

The arguments for relaxing alcohol licensing on economic grounds do not stack up against the billions lost to alcohol-related sickness, crime and reduced productivity. While it may be time to update and streamline the licensing process, any new framework must not dilute local control of licensing decisions or sideline public health priorities. With consultation on licensing reform underway, the government should put health in the foreground by making it a formal licensing objective for local authorities. This would empower Directors of Public Health to influence local decisions on how alcohol is sold, particularly in areas with high outlet density and entrenched harm. 

The 10-Year Health Plan makes a nod to alcohol-related harms. But, as we and others have argued elsewhere, the government needs to do more to make good on Wes Streeting’s promise to confront vested interests. A good start would be to reconsider proposals to loosen licensing regulations and urgently open consultation on what we know works in tackling alcohol-related harm: minimum unit pricing for England, restrictions on marketing and sponsorship, and stricter controls on availability.